Arenavirus Infection -- Connecticut, 1994

On August 20, 1994, the Connecticut Department of Public
Health and Addiction Services received a report of a case of acute
illness in a virologist suspected to be associated with Sabia
virus, a newly described arenavirus. This report presents
preliminary findings from the case investigation.

On August 19, 1994, the virologist presented to the Tropical
Medicine Clinic at Yale-New Haven Hospital with a 4-day history of
fever, malaise, backache, stiff neck, and myalgias that he
attributed to a recurrence of a Plasmodium vivax infection. On
evaluation at the clinic, his temperature was 99.8 F (37.6 C) on
antipyretics, and he had a normal physical examination. Laboratory
evaluation included a negative malaria smear, a total white blood
cell count (WBC) of 2600 cells/mm3 (normal: 4000-10,000 cells/mm3),
a platelet count of 138,000 cells/mm3 (normal: 150,000-350,000
cells/mm3), 2+ proteinuria, and alanine aminotransferase (ALT) of
6356 U/L (upper limit normal: 35 U/L).

A history of a possible laboratory exposure to Sabia virus was
obtained, and the man was hospitalized for prompt treatment with
intravenous ribavirin, an antiviral drug that is effective against
other arenavirus infections such as Lassa fever (1).

On admission, the patient had a temperature of 103 F (39.4 C).
Within 24 hours of hospitalization, his total WBC and platelet
count had declined to a low of 1400 cells/mm3 and 92,000 cells/mm3,
respectively. His ALT peaked at 128 U/L on the 9th day of
hospitalization. No hemorrhagic manifestations of the infection
were observed during hospitalization. A diagnosis of Sabia
infection was confirmed on acute serum by amplification of a
portion of the viral genome by polymerase chain reaction and by
isolation of the virus from blood. The patient recovered and was
discharged on August 26.

On August 8, the virologist was apparently exposed to an
aerosol of Sabia virus when a centrifuge bottle developed a crack,
and tissue culture supernatant containing the virus leaked into the
high-speed centrifuge. At the time of the incident, the virologist
was working alone in the biosafety level-3 laboratory (negative
pressure with HEPA-filtered exhaust system). He cleaned the spilled
material from the centrifuge while wearing a gown, surgical mask,
and gloves.

Editorial Note

Editorial Note: Sabia virus was isolated by scientists in Sau
Paulo, Brazil, in 1990 and characterized by scientists in Belem,
Brazil, and at the Yale Arbovirus Research Unit (2). Only two cases
of Sabia virus infection (both in Brazil) have been reported (2).
One was a naturally acquired infection in an agricultural engineer
who was probably infected by exposure to an infected rodent (the
natural reservoir of other known arenaviruses). The engineer died
approximately 2 weeks after becoming ill. The second case was in a
laboratory technician who was working with the virus. He had a
severe illness characterized by 15 days of fever, chills, malaise,
headache, generalized myalgia, sore throat, conjunctivitis, nausea,
vomiting, diarrhea, epigastric pain, bleeding gums, and leukopenia.
He recovered after hospitalization and treatment with intravenous
fluids.

Little is known about the modes of transmission of the Sabia
virus. Based on the pathogenesis of other arenaviruses, the Sabia
virus is not believed to be infectious until the patient exhibits
symptoms. Other arenaviruses can be transmitted by needle-stick but
do not readily spread from person to person. Persons in casual
contact with persons with arenavirus infection are not at risk for
disease and do not require medical follow-up.

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